title: The Pavlik harness in the treatment of developmentally dislocated hips: results of Japanese multicenter studies in 1994 and 2008.
abstract: BACKGROUND
  It has already been more than 50 years since the Pavlik harness was introduced in Japan, and today the Pavlik harness is widely recognized as the standard initial treatment modality for developmental dysplasia of the hip. We performed a multicenter nationwide questionnaire study concerning the results of Pavlik harness treatment twice in 1994 and 2008.
  
  
  METHODS
  In 1994 and in 2008, we sent questionnaires to 12 institutes in Japan specializing mainly in pediatric orthopedics. We compare the results of these two studies and discuss differences in reduction rates, incidence of avascular necrosis in the femoral epiphysis and the percentage of joints with acceptable morphology (Severin grade I + II/total) at skeletal maturity. We statistically assessed these results to see whether there were changes in the treatment outcomes over this 14-year period.
  
  
  RESULTS
  Reduction of the dislocated hips was obtained by the Pavlik harness in 80.2% (1990/2481 hips; 1994) and 81.9% (1248/1523 hips; 2008). The incidences of avascular necrosis of the proximal femoral epiphysis in the dysplastic hips were 14.3% (119/835 hips; 1994) and 11.5% (76/663 hips; 2008). The type of avascular necrosis in hips from the 2008 study was determined according to the classification of Kalamchi and MacEwen: 24/69 hips (34.8%) were classified as group I; 20/69 hips (29.0%) as group II; 11/69 hips (15.9%) as group Ill; 14/69 hips (20.3%) as group IV. The percentages of hips with acceptable outcomes at skeletal maturity discerned from Severin X-ray changes (grade I + II/total) were 72.3% (604/835 hips; 1994) and 77.7% (488/628 hips; 2008).
  
  
  CONCLUSIONS
  Reduction rates and the incidence of avascular necrosis in 2008 were statistically similar to the results in 1994. The rate of acceptable outcome (Severin grade I + II/total) in 2008 was statistically higher than that of 1994.
authors.affiliation: Department of Functional Anatomy and Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan.
authors.forename: Ikuo
authors.initials: I
authors.lastname: Wada
authors.forename: Eisuke
authors.initials: E
authors.lastname: Sakuma
authors.forename: Takanobu
authors.initials: T
authors.lastname: Otsuka
authors.forename: Kenjiro
authors.initials: K
authors.lastname: Wakabayashi
authors.forename: Kinya
authors.initials: K
authors.lastname: Ito
authors.forename: Osamu
authors.initials: O
authors.lastname: Horiuchi
authors.forename: Yoshimi
authors.initials: Y
authors.lastname: Asagai
authors.forename: Makoto
authors.initials: M
authors.lastname: Kamegaya
authors.forename: Eiji
authors.initials: E
authors.lastname: Goto
authors.forename: Shinichi
authors.initials: S
authors.lastname: Satsuma
authors.forename: Daisuke
authors.initials: D
authors.lastname: Kobayashi
authors.forename: Susumu
authors.initials: S
authors.lastname: Saito
authors.forename: Mayuki
authors.initials: M
authors.lastname: Taketa
authors.forename: Kazuharu
authors.initials: K
authors.lastname: Takikawa
authors.forename: Yasuharu
authors.initials: Y
authors.lastname: Nakashima
authors.forename: Tadashi
authors.initials: T
authors.lastname: Hattori
authors.forename: Shigeru
authors.initials: S
authors.lastname: Mitani
authors.forename: Akifusa
authors.initials: A
authors.lastname: Wada
mesh_terms: D000293:Adolescent; D001915:Braces; D004867:Equipment Design; D005500:Follow-Up Studies; D006618:Hip Dislocation, Congenital / Q000628:therapy*; D006801:Humans; D007564:Japan; D015337:Multicenter Studies as Topic; D013997:Time Factors